Prenatal Nutrition.doc

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					                                                         Kathryn H. Thompson, Ph.D.
                                                                    April 11, 2001

                      Prenatal Nutrition and Lactation


   To produce a healthy, normal weight infant while minimizing the short and
    long term health risks to the mother

   To determine the appropriate weight gain during pregnancy for the normal
    weight underweight and overweight pregnant woman

   To recognize the additional energy, vitamin and mineral requirements during
    pregnancy and lactation

   To recommend dietary modifications to help alleviate nausea, heartburn and
    constipation during pregnancy

   To develop skills to help promote and maintain breast-feeding

                               Prenatal Nutrition

I.      Questions with nutritional implications for the obstetric history

     and physical exam

     A. Present illness

        1. General: recent weight change, poor weight gain, edema, dehydration

        2. G.I. complaints: Diarrhea, nausea, vomiting, heartburn, constipation

     B. Medical History

        1. Prenatal vitamins, nutritional supplements, herbs, remedies?

        2. Iron supplements/

        3. Food allergies

        4. Non-food cravings

        5. Obstetric history

     C. Social History

        1. Alcohol?

        2. Special Diet?

   3. How many meals and snacks daily?

   4. Avoid any specific foods?

   5. Milk: how much, type?

   6. Lactose intolerance

D. Family History

   1. Familial occurrence of dx

   2. History of children with fetal anomalies

E. Review of symptoms

   1. General: Fatigue, weight change

   2. Month: teeth, gums, lips, tongue

   3. GI/abdomen: Appetite, food intolerance, nausea, constipation, diarrhea

F. Physical Exam

   1. Anthropometric data

      a Height

      b Current weight

         c   Prepregnancy weight

         d Prepregnancy BMI

         e Weight gain during pregnancy so far

  G. Laboratory Evaluation

      1. Glucose

      2. Hematocrit

      3. Hemoglobin

II.   Maternal weight gain

  A. Underweight

      1. BMI < 19.8

      2. Total weight gain 28 - 40 lbs.

      3. 5 lbs./ 4 weeks

  B. Normal

      1. BMI = 19.8 - 26

      2. Total weight gain 25 - 35 lbs.

      3. 4 lbs./ 4 weeks

  C. Overweight

      1. BMI = 26.1 -29

      2. Total weight gain 15 - 25 lbs.

      3. 2.6 lbs./ 4 weeks

III. Nutritional requirements

  A. Energy: + 300 kcal in 2nd and 3rd trimester

  B. Protein: RDA = 60 g

  C. Calcium

  D. Folate

  E. Iron

IV.   Nutritional Problems

  A. Nausea and vomiting

  B. Constipation

  C. Heartburn


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